Mullen J C, Khan N, Weisel R D, Christakis G T, Teoh K H, Madonik M, Mickle D A, Ivanov J
Division of Cardiovascular Surgery, Toronto General Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1987 Oct;94(4):558-65.
Cardioplegia provides excellent protection for the left ventricle, but the right atrium may be poorly protected. Myocardial temperatures, right atrial electrical activity, and postoperative arrhythmias were assessed in 103 patients participating in two consecutive randomized trials comparing blood cardioplegia (n = 36), crystalloid cardioplegia (n = 38), and diltiazem crystalloid cardioplegia (n = 29). Both right atrial and right ventricular temperatures were significantly warmer (p less than 0.05) during delivery of the blood cardioplegic solution than during delivery of either the crystalloid or the diltiazem crystalloid cardioplegic solutions; the aortic root temperatures were 9 degrees +/- 2 degrees C with blood cardioplegia and 5 degrees + 1 degrees C with both crystalloid and diltiazem crystalloid cardioplegia. Atrial activity during cardioplegic arrest was greatest with blood cardioplegia (12 +/- 3 beats/min), lower with crystalloid cardioplegia (10 +/- 2 beats/min), and minimal with diltiazem crystalloid cardioplegia (5 +/- 1 beats/min, p less than 0.05). Perioperative ischemic injury (by creatine kinase MB isoenzyme analysis) was greatest with crystalloid cardioplegia (p less than 0.05). Postoperative supraventricular arrhythmias (both treated and untreated) were more frequent after crystalloid cardioplegia (crystalloid, 63%; blood, 40%; diltiazem, 47%; p less than 0.05). Patients in whom supraventricular arrhythmias developed had significantly more postoperative ischemic injury (by creatinine kinase MB isoenzyme analysis, p less than 0.05). Blood cardioplegia reduced supraventricular arrhythmias by reducing ischemic injury despite warmer intraoperative temperatures and more right atrial activity. Diltiazem crystalloid cardioplegia reduced postoperative arrhythmias by improving intraoperative myocardial protection and suppressing intraoperative and postoperative atrial activity. Crystalloid cardioplegia cooled but did not arrest the right atrium intraoperatively, resulted in the most perioperative ischemic injury, and yielded the highest incidence of postoperative supraventricular arrhythmias.
心脏停搏液能为左心室提供良好的保护，但右心房可能保护不佳。在103例参与两项连续随机试验的患者中，评估了心肌温度、右心房电活动和术后心律失常情况，这些试验比较了含血心脏停搏液（n = 36）、晶体心脏停搏液（n = 38）和地尔硫䓬晶体心脏停搏液（n = 29）。在输注含血心脏停搏液期间，右心房和右心室温度均显著高于输注晶体或地尔硫䓬晶体心脏停搏液期间（p < 0.05）；含血心脏停搏液时主动脉根部温度为9℃±2℃，晶体和地尔硫䓬晶体心脏停搏液时为5℃±1℃。心脏停搏期间，含血心脏停搏液时心房活动最活跃（12±3次/分钟），晶体心脏停搏液时较低（10±2次/分钟），地尔硫䓬晶体心脏停搏液时最少（5±1次/分钟，p < 0.05）。围手术期缺血损伤（通过肌酸激酶MB同工酶分析）以晶体心脏停搏液组最为严重（p < 0.05）。晶体心脏停搏液术后室上性心律失常（包括治疗和未治疗的）发生率更高（晶体组63%；含血组40%；地尔硫䓬组47%；p < 0.05）。发生室上性心律失常的患者术后缺血损伤明显更严重（通过肌酸激酶MB同工酶分析，p < 0.05）。尽管术中温度较高且右心房活动较多，但含血心脏停搏液通过减少缺血损伤降低了室上性心律失常的发生。地尔硫䓬晶体心脏停搏液通过改善术中心肌保护并抑制术中及术后心房活动，降低了术后心律失常的发生。晶体心脏停搏液可使右心房在术中降温但未使其停搏，导致围手术期缺血损伤最严重，且术后室上性心律失常发生率最高。
